Regina Belski

Metabolic syndrome (MS) is associated with a range of chronic diseases, for which lifestyle interventions are considered the cornerstone of treatment. Dietary interventions have primarily focused on weight reduction, usually via energy restricted diets. While this strategy can improve insulin sensitivity and other health markers, weight loss alone is not always effective in addressing all risk factors associated with MS. Previous studies have identified diet quality as a key factor in reducing the risk of MS independent of weight loss. Additionally, supporting evidence for the use of novel strategies such as carbohydrate restriction and modifying the frequency and timing of meals is growing. It is well established that dietary assessment tools capable of identifying dietary patterns known to increase the risk of MS are essential for the development of personalised, targeted diet and lifestyle advice. The American Heart Association (AHA) recently evaluated the latest in a variety of assessment tools, recommending three that demonstrate the highest evidence-based and clinical relevance. However, such tools may not assess and thus identify all dietary and eating patterns associated with MS development and treatment, especially those which are new and emerging. This paper offers a review of current dietary assessment tools recommended for use by the AHA to assess dietary and eating patterns associated with MS development. We discuss how these recommendations align with recent and novel evidence on the benefits of restricting ultra-processed food and refined carbohydrates and modifying timing and frequency of meals. Finally, we provide recommendations for future redevelopment of these tools to be deployed in health care settings.

(1) Background: Community sport settings present a range of conflicting health behaviours, including the tension between being physically active and consuming discretionary foods. Therefore, community sport settings are considered a promising location for health promotion. The aim of this project was to evaluate perceptions, knowledge and the impact (e.g., barriers and outcomes) of a healthy-canteen (cafeteria) display, based on traffic light labeling (TLL), which was set up at an Australian Basketball Association Managers’ Convention and Trade Show. (2) Methods: We set up a healthy ‘canteen display and surveyed Basketball managers on their perceptions of the display before (Survey 1) and after (Survey 2) visiting the display. Three months later they were surveyed (Survey 3) on changes made to their community sport canteens. (3) Results: Eighty-eight, 76 and 22 participants completed Surveys 1, 2 and 3, respectively. Participants believed stocking healthy foods and beverages was important (mean 8.5/10). Food waste, lack of consumer interest and price were identified barriers to stocking healthy foods. After visiting the display, 75% were inspired to make changes and 50% were surprised by the differences between their perceptions of the healthfulness of foods and the TLL ratings. Post-convention, 41% and 70% made or had planned healthy changes to their community sport canteen. (4) Conclusions: A healthy-canteen display is a low-cost, easy-to-implement strategy that may be able to direct self-driven improvement in the healthfulness of foods stocked at community canteens and lead to improved nutritional intakes at these venues.

(1) Background: Many professional Australian Football (AF) players do not meet recommended sports nutrition guidelines despite having access to nutrition advice. There are a range of factors that can influence players′ ability to meet their nutrition goals and awareness of the barriers players face is essential to ensure that dietary advice translates into practice. Therefore, this qualitative research study aimed to explore the factors influencing AF players’ dietary intakes and food choice. (2) Methods: Semi-structured interviews were conducted with twelve professional male AF players. (3) Results: Less experienced players restricted their carbohydrate intake to meet body composition goals, particularly during preseason and surrounding body composition assessment. During the competition season players had a greater focus on performance and placed more emphasis on carbohydrate intake in the lead up to matches. Players felt nutrition goals were easier to achieve when dietary choices were supported by their families and peers. One-on-one consultations provided by a sports dietitian were players′ preferred mode of nutrition intervention. Individualized nutrition advice is required for less experienced AF players who may be vulnerable to unsustainable dietary habits. Experienced AF players can support junior teammates by promoting positive team culture related to body composition, nutrition and performance.

Animal studies have demonstrated that energy-restricted diets and exercise affect the gut microbiome and are positively linked to physical health; however, less is known about the impacts of various patterns of dietary restriction combined with exercise on the gut microbiota and associated health outcomes in humans. This study aimed to determine if an energy-restricted diet combined with resistance training altered the gut microbiome, and whether any changes were associated with differences in body composition, dietary intake, or biomarkers of metabolic health. Twenty-six healthy males and females, aged 19–36 years with BMIs of 22–35 kg/m², were enrolled in a 2-arm parallel, randomized controlled trial and followed either a 5:2 intermittent fasting (IFT, n = 13) or continuous energy restriction (CERT, n = 13) diet combined with supervised resistance training for 12 weeks. Both treatments resulted in decreased body weight and increased lean body mass. Shifts in the abundance of, Faecalibacterium prausnitzii, a high butyrate producer, was positively associated with changes in lean body mass (IFTp = 0.05, CERTp = 0.01) in both the groups. Moreover, in the CERT group, changes in Coprococcus genus were negatively associated with energy (p = 0.009) and fat intake (p= 0.03) and positively associated with body fat (p = 0.02). Overall, the findings indicate that using resistance training paired with either intermittent or continuous energy restriction, result in similar changes in bacterial diversity and shifts in relative abundance of bacterial taxa. The shift in specific bacterial taxa were positively associated with measures of physical health providing further support to the proposed relationship between energy consumption, exercise, gut microbiota, and physical health.

Diets utilising intermittent fasting (IF) as a strategic method to manipulate body composition have recently grown in popularity, however, dietary practices involving fasting have also been followed for centuries for religious reasons (i.e., Ramadan). Regardless of the reasons for engaging in IF, the impacts on lean body mass (LBM) may be detrimental. Previous research has demonstrated that resistance training promotes LBM accrual, however, whether this still occurs during IF is unclear. Therefore, the objective of this review is to systematically analyse human studies investigating the effects of variations of IF combined with resistance training on changes in LBM in previously sedentary or trained (non-elite) individuals. Changes in body weight and fat mass, and protocol adherence were assessed as a secondary objective. This review followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. MEDLINE, CINAHL, PubMed and SportDiscus databases were searched for articles investigating IF, combined with resistance training that reported measures of body composition. Eight studies met the eligibility criteria. LBM was generally maintained, while one study reported a significant increase in LBM. Body fat mass or percentage was significantly reduced in five of eight studies. Results suggest that IF paired with resistance training generally maintains LBM, and can also promote fat loss. Future research should examine longer-term effects of various forms of IF combined with resistance training compared to traditional forms of energy restriction. Prospero registration CRD42018103867.

Background: Retirement from elite sport is a unique transition that influences significant identity, body, and lifestyle changes. This mixed-studies systematic literature review reports on athletic retirement, maladaptive eating behaviours, and body dissatisfaction. Methods: The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were followed to search the following databases: Web of Science, Scopus, PubMed, EBSCO Host, Sport Discus, and CINAHL. Sixteen studies were synthesised and contrasted through thematic analysis to develop three overarching themes. Results: The three themes that arose include body dissatisfaction and grief, disordered eating and compensation, and long term influence of sporting culture. Maladaptive and compensatory behaviours can arise from sustained athletic identity, body grief, lack of education, and contradictory body ideals. Conclusion: The concept Athletic Body Transition is defined as exploring how a lack of body acceptance may lead to maladaptive behaviours related to food, exercise, and body arising in this transitory period. This review identifies the need for sporting organisations and health professionals to acknowledge this significant transition in regards to athletes’ relationship with food and body subsequent to a sporting career.

Background: to develop sport-specific and effective dietary advice, it is important to understand the dietary intakes of team sport athletes. This systematic literature review aims to (1) assess the dietary intakes of professional and semi-professional team sport athletes and (2) to identify priority areas for dietetic intervention. Methods: an extensive search of MEDLINE, Sports DISCUS, CINAHL, Web of Science, and Scopus databases in April–May 2018 was conducted and identified 646 studies. Included studies recruited team sport, competitive (i.e., professional or semi-professional) athletes over the age of 18 years. An assessment of dietary intake in studies was required and due to the variability of data (i.e., nutrient and food group data) a meta-analysis was not undertaken. Two independent authors extracted data using a standardised process. Results: 21 (n = 511) studies that assessed dietary intake of team sport athletes met the inclusion criteria. Most reported that professional and semi-professional athletes’ dietary intakes met or exceeded recommendations during training and competition for protein and/or fat, but not energy and carbohydrate. Limitations in articles include small sample sizes, heterogeneity of data and existence of underreporting. Conclusions: this review highlights the need for sport-specific dietary recommendations that focus on energy and carbohydrate intake. Further exploration of factors influencing athletes’ dietary intakes including why athletes’ dietary intakes do not meet energy and/or carbohydrate recommendations is required.

Lower copy number variations (CNVs) in the salivary amylase gene (AMY1) have been associated with obesity and insulin resistance; however, the relationship between AMY1 and cardiometabolic risk has not been fully elucidated. Using gold-standard measures, we aimed to examine whether AMY1 CNVs are associated with cardiometabolic risk factors in an overweight or obese, otherwise healthy population. Fifty-seven adults (58% male) aged 31.17 ± 8.44 years with a body mass index (BMI) ≥25 kg/m² were included in the study. We measured AMY1 CNVs (qPCR); anthropometry (BMI; body composition by dual-energy X-ray absorptiometry); cardiovascular parameters (blood pressure, serum lipids by ELISA); insulin sensitivity (hyperinsulinaemic–euglycaemic clamp), insulin secretion (intravenous glucose tolerance test), and serum inflammation markers (multiplex assays). Based on previous studies and median values, participants were divided into low (≤4) and high (>4) AMY1 CNV groups. Low AMY1 carriers (n = 29) had a higher fat mass (40.76 ± 12.11 versus 33.33 ± 8.50 kg, p = 0.009) and LDL-cholesterol (3.27 ± 0.80 versus 2.87 ± 0.69 mmol/L, p = 0.038), and higher serum levels of interleukin [IL]-6, IL-1β, tumour necrosis factor-alpha and monocyte chemoattractant protein-1 (MCP-1) (all p < 0.05) compared with high AMY1 carriers (n = 28), but there were no differences in glycaemic measures, including insulin sensitivity or secretion (all p > 0.1). Except for MCP-1, the results remained significant in multivariable models adjusted for age, sex, and fat mass (all p < 0.05). Our findings suggest that low AMY1 CNVs are associated with increased cardiovascular disease risk and inflammation, but not glucose metabolism, in overweight or obese adults.

New evidence and feedback from colleagues have led to modifications to the Nutrition for Sport Knowledge Questionnaire (NSKQ) and Abridged Nutrition for Sport Knowledge Questionnaire (ANSKQ). The changes predominately affect questions regarding the nutrient content of foods, protein recommendations and the legality of supplements. Some English language edits have also been made.

Sports Dietitians aim to assist in improving performance by developing nutrition knowledge (NK), enhancing dietary intake and optimising body composition of athletes. In a high-pressure environment, it is important to identify factors that may compromise an athlete’s nutrition status. Body composition assessments are regularly undertaken in sport to provide feedback on training adaptions; however, no research has explored the impact of these assessments on the dietary intake of professional athletes. This cross-sectional study assessed dietary intake (7-day food diary), nutrition knowledge (Nutrition for Sport Knowledge Questionnaire) and body composition (Dual-energy X-ray absorptiometry) of 46 professional male Australian football (AFL) athletes during a 2017 pre-season training week (7 days) where body composition assessments were undertaken. Dietary intake was assessed against International Olympic Committee recommendations for professional athletes. Overall, no athlete met dietary their recommended energy intake (15 ± 1.1 vs. 9.1 ± 1.8 MJ, respectively) or carbohydrate recommendations (6–10 vs. 2.4 ± 0.9 g·kg-1·day-1). Only 54% met protein recommendations. Secondary analyses demonstrated significant associations between education status and energy intake (P < 0.04) and vegetable intake (P < 0.03), with higher levels of education being associated with higher intakes. A moderately positive association was observed between NK scores and meeting estimated energy requirements (r = 0.33, P = 0.03). NK scores were also positively associated with protein (r = 0.35, P = 0.02), fibre (r = 0.51, P = 0.001) and calcium intakes (r = 0.43, P = 0.004). This research identified that the dietary intake of professional AFL athletes during a pre-season training week where body composition assessments were undertaken did not meet current recommendations. Several factors may influence the dietary intake of AFL athletes, including lower education levels, poor NK and dietary intake restriction surrounding body composition assessment. Athletes may require support to continue with performance-based nutrition plans in periods surrounding body composition assessment.